The Peripheral Neuropathy Evaluation in an Office-Based Neurology Setting

Vavra, Michael W.; Rubin, Devon I.

doi:10.1055/s-0031-1271305

Cited by 13 publications

(20 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To address this uncertainty, we reviewed numerous articles, reviews and book chapters for published definitions, the most salient of which are here cited 12,114,[125][126][127][128][129][130][131][132][133][134][135][136][137] , and identified key elements of a complete and unambiguous definition of multifocal neuropathy. These elements are as follows: involvement of two or more individual, named peripheral nerves and not unnamed nerve twigs; limitation to the sensorimotor somatic and not the autonomic PNS; involvement defined clinically by distribution of weakness or sensory loss; no overlap or contiguity between affected nerves; applicability of the definition to any peripheral or cranial nerve; and allowance for nerves to be affected either sequentially or simultaneously.…”

Section: Multifocal Neuropathy: Definitionmentioning

confidence: 99%

The nonsystemic vasculitic neuropathies

2017

View full text Add to dashboard Cite

The vasculitides are a clinically diverse group of diseases with the histopathological signature of blood vessel-centred inflammation that results in vascular damage and ischaemic injury to the affected tissues 1 . Vasculitis can be caused by drugs, infections and cancers, but diagnostic workup reveals no trigger in most patients. Autoimmune mechanisms are active in all vasculitides, except those caused by direct infection of vessel walls. Most vasculitides are systemic and involve multiple organs and tissues. Those affecting small-to medium-sized vessels often manifest with a vasculitic neuropathy. For example, neuropathies occur in 60-70% of patients with polyarteritis nodosa, eosinophilic granulomatosis with polyangiitis and cryoglobulinaemic vasculitis, and 40-50% of those with microscopic polyangiitis and rheumatoid vasculitis 2 .Vasculitic neuropathy can also occur without systemic vasculitis. This single-organ vasculitis of the PNS has commonly been referred to as nonsystemic vasculitic neuropathy (NSVN), but other forms of clinically isolated PNS vasculitis are now recognized and can be considered variants of NSVN 3 . Although NSVN is classically an acute, relapsing, multifocal neuropathy, it can present as a slowly progressive neuropathy without distinct asymmetries. As such, it should be considered as a possible cause of any progressive axonal neur opathy. NSVN can be diagnosed only with a nerve biopsy, with or without a concomitant muscle or skin biopsy; as nerve biopsies are seldom performed, the condition is under-recognized. The disorder must be distinguished from many other causes of multifocal neuropathy, the definition of which is itself not standardized and requires clarification.A Peripheral Nerve Society guideline group reviewed the literature on vasculitic neuropathy and published consensus recommendations on the classification, diagnosis and immunosuppressive treatment of NSVN in 2010 (REF. 4) Abstract | Nonsystemic vasculitic neuropathy (NSVN) is an under-recognized single-organ vasculitis of peripheral nerves that can only be diagnosed with a nerve biopsy. A Peripheral Nerve Society guideline group published consensus recommendations on the classification, diagnosis and treatment of NSVN in 2010, and new diagnostic criteria for vasculitic neuropathy were developed by the Brighton Collaboration in 2015. In this Review, we provide an update on the classification, diagnosis and treatment of NSVN. NSVN subtypes include Wartenberg migratory sensory neuropathy and postsurgical inflammatory neuropathy. Variants include diabetic radiculoplexus neuropathy and -arguably -neuralgic amyotrophy. NSVN with proximal involvement is sometimes termed nondiabetic lumbosacral radiculoplexus neuropathy. Cutaneous polyarteritis nodosa and other skin-nerve vasculitides overlap with NSVN clinically. Three patterns of involvement in NSVN have been identified: multifocal neuropathy, distal symmetric polyneuropathy, and overlapping multifocal neuropathy (asymmetric polyneuropathy). These patterns lack standard defi...

show abstract

Section: Multifocal Neuropathy: Definitionmentioning

confidence: 99%

The nonsystemic vasculitic neuropathies

2017

View full text Add to dashboard Cite

show abstract

“…Kelly stated that most experts believe that neurophysiologic testing is the most useful diagnostic tool after the clinical exam . Vavra and Rubin concluded that EDx testing should be used in almost all cases of peripheral neuropathy . They included all suspected peripheral neuropathies but noted that the large majority were DSP.…”

Section: What Are the Expert Opinions?mentioning

confidence: 99%

“…Polyneuropathy is among the most common problems seen in practice, with an overall incidence of 2.4% in the United States population . A majority of polyneuropathy cases are distal symmetric polyneuropathy (DSP) .…”

mentioning

confidence: 99%

“…lems seen in practice, with an overall incidence of 2.4% in the United States population. [1][2][3] A majority of polyneuropathy cases are distal symmetric polyneuropathy (DSP). 4 Although diabetes mellitus is the most common cause of DSP, 5 there are well over 200 identified causes of peripheral neuropathy.…”

mentioning

confidence: 99%

“…11 Vavra and Rubin concluded that EDx testing should be used in almost all cases of peripheral neuropathy. 3 They included all suspected peripheral neuropathies but noted that the large majority were DSP. In contrast, Callaghan et al suggested that EDx studies are not needed in the large majority of polyneuropathy cases.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Is electrodiagnosic testing for polyneuropathy overutilized?

Bodofsky

Carter²,

England

2016

Muscle Nerve

View full text Add to dashboard Cite

Distal symmetric polyneuropathy (DSP) is one of the most common problems seen in clinical practice and one of the most frequent reasons for electrodiagnostic (EDx) testing. Most studies have supported the use of EDx testing for patients with suspected DSP. Some recent articles assert that EDx testing has a low yield in suspected DSP and is only needed for atypical presentations (a minority). However, many peer-reviewed articles indicate that EDx frequently changes diagnosis and management, and leads to a better understanding of the underlying pathology, severity, and prognosis. Overall, EDx is appropriate for most patients with new signs and symptoms of DSP. Muscle Nerve 55: 301-304, 2017.

show abstract

Clinical Aspects of Peripheral Neuropathy

Bilbao

Schmidt

2014

Biopsy Diagnosis of Peripheral Neuropathy

View full text Add to dashboard Cite

The Peripheral Neuropathy Evaluation in an Office-Based Neurology Setting

Cited by 13 publications

References 54 publications

The nonsystemic vasculitic neuropathies

The nonsystemic vasculitic neuropathies

Is electrodiagnosic testing for polyneuropathy overutilized?

Clinical Aspects of Peripheral Neuropathy

Contact Info

Product

Resources

About